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In 2001, the Agency for Healthcare Research and Quality recommended the use of ultrasound for the placement of central venous catheters (CVCs) as one of their 11 practices to improve patient care. These recommendations were based on the results of several randomized clinical trials showing significantly improved overall success as well as reductions in complications. This article will describe the practical aspects of using ultrasound to guide placement of CVCs in the internal jugular vein in a "how I do it" approach, as well as review the practice management and training aspects related to incorporating ultrasound into daily practice.

Central vascular access is sometimes required for hemodynamic monitoring and infusion of fluids and medications in the pediatric emergency department. In many cases, it is attempted after failed peripheral venous and intraosseous access. Some evidence exists demonstrating benefits of ultrasound (US)-guided central vascular cannulation in adults in emergency departments. With appropriate education in its use, US-guided cannulation of central veins in children is likely to be associated with less complications and greater success. In the pediatric emergency department, the femoral vein is the most practical central venous cannulation site. A sound educational and quality assurance program is necessary for US-guided cannulation in the pediatric emergency department.